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COPD Healthcare Atlas

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COPD Healthcare Atlas COPD Healthcare Atlas Use of health services in connection with chronic obstructive pulmonary disease in Norway, 2013-2015 Helseatlas SKDE report Num. 1/2018 Editor Barthold Vonen Main author Linda Leivseth Co-authors Gunnar Reksten Husebø, Hasse Melbye, Rune Grønseth, Hanne Sigrun Byhring, Frank Olsen, Bård Uleberg, Olav Helge Førde, Arnfinn Hykkerud Steindal, Lise Balteskard, Toril Bakken Awarding authority Ministry of Health and Care Services, and Northern Norway Regional Health Authority Date (Norwegian version) October 2017 Date (English version) March 2018 Translation Allegro (Anneli Olsbø) Version March 14, 2018 Front page photo: Colourbox ISBN: 978-82-93141-33-4 All rights SKDE. Foreword Northern Norway Regional Health Authority The COPD Healthcare Atlas from the Centre for Clinical Documentation and Evaluation (SKDE) provides new and important information about the population’s use of health services in connection with COPD. According to WHO, the prevalence of the disease is increasing rapidly worldwide. In 2020, COPD will be the third leading cause of death worldwide. The main cause is smoking. At least 200,000 Norwegians suffer from COPD. The big picture is that the healthcare atlas shows geographical, but not much unwarranted, variation in the population’s use of health services in connection with COPD. That is positive. Does this mean that the atlas gives the health services for this group of patients a clean bill of health? Not really. Lung function testing using spirometry is the ‘gold standard’ examination for determining whether or not a person has COPD, and for monitoring the disease’s development. The healthcare atlas shows variation between geographical areas in the proportion of persons with COPD who have undergone spirometry. Moreover, the proportion seems to be too low in all the hospital referral areas. Many persons with COPD experience acute exacerbations that require hospital admission. Some of them will need help to breathe (respiratory support). The COPD Healthcare Atlas identifies unwarranted variation in the use of respiratory support in connection with emergency admissions for COPD. This means that there are individual patients who do not receive the most adequate healthcare they should have. Persons admitted with COPD exacerbations have a high risk of being readmitted within 30 days and of dying within one year. The most important thing to do to improve the treatment offered to this patient group is to address the unwarranted variation that the COPD Healthcare Atlas identifies and to establish a common best practice. In addition, there are many indications that it is a good idea to ensure that people get help before the disease has become very serious. It is important to initiate treatment of acute COPD exacerbations quickly in order to avoid hospitalisation. The second most important thing is to increase patients’ possibility of maintaining as optimal a lifestyle as possible and to avoid situations that could exacerbate the disease. Patient education and coping services are a sound and reasonable investment. This will also help to reduce the load on the hospitals that provide emergency medical services. Historically speaking, COPD has been regarded as a low-status disease by patients, as well as by the health services and society at large. Health problems that can be lifestyle-related or for which few treatment options are available have not been at the top of the health service’s ranking, and cancer, heart disease and other acute conditions receive more attention. It is my hope that the COPD Healthcare Atlas will, in an informed manner, draw attention to the treatment offered to a large group of people who deserve to receive good help for their significant long-term health problems. This is in the best interests of the people in question, the health service and society at large. Lars Vorland Managing Director Northern Norway Regional Health Authority The Norwegian Respiratory Society The health service’s primary function, in addition to preventing and curing diseases, is to relieve suffering and prevent premature deaths. We have substantial funds at our disposal, but society’s resources are not inexhaustible. As doctors, we constantly make big and small decisions that entail expenses for the public purse. This means that we have an obligation to use our knowledge to maximise the health benefit per krone spent. The treatment options available for COPD have improved considerably in the past two decades. As a result, patients live longer and the use of health services thereby increases. This is a big patient group, and it is therefore important that we make wise decisions when we assess, treat and follow up these patients. Comparing the way in which health services are organised in one’s own and other organisations can encourage a critical fresh look at the prevailing practices. The key is to ensure that the measures that deliver health benefit with reasonable resource use, such as lifestyle intervention, rehabilitation and spirometry monitoring, are actually implemented. However, making wise decisions also means refraining from measures that lack documented effect. This COPD Healthcare Atlas can help us pulmonologists to understand where the problems lie in our field. The healthcare atlas can encourage us not only to reconsider our procedures, butalso to make an effort to improve cooperation with the primary healthcare services, for example in the form of teaching. It focuses on the simple, but important, measures that can and should be carried out by primary care physicians to follow up COPD patients, and on how to select the right patients for referral to the specialist health service. Some interesting variations between the different health trusts’ hospital referral areas are pointed out. Examples include the use of outpatient services, length of stays and non-invasive ventilation (NIV). This gives rise to many new questions. There is no strong correlation between the number of outpatient contacts and emergency admissions. Could it be that the quality of routine check-ups of COPD patients is good enough in the primary healthcare service? Could some hospitals cut the length of stays and maintain the same level of quality, for example by improving their cooperation with the municipal health service? Is NIV overused in some places, while other hospitals have a low threshold for admitting patients and therefore less need for NIV? Or is this an indication of under-registration? The material forms a basis for many interesting discussions. We would have liked to have figures for more areas, for example for the use of long-term treatment with oxygen and nebulisers, which probably also varies between different hospital referral areas, but those figures are not available in the same way. A COPD register with high coverage wouldbe desirable. The Norwegian Respiratory Society appreciates the good work done in this context. This publi- cation collects a lot of knowledge about COPD and provides extensive data that will be useful in further work for this group of patients. Trond Bjørge Deputy leader The Norwegian Respiratory Society The National Register for Patients with Chronic Obstructive Pulmonary Disease COPD is a very serious disease that is very common in Norway. The treatment provided to patients with COPD by Norwegian hospitals may seem random and unsystematic. Patients are spread be- tween different hospital departments, and the care pathways are often not good enough. Despite the increasing attention given to COPD by the media, politicians and patient organisations in recent years, there is still a great need for more knowledge about the condition. The COPD Healthcare Atlas contributes important knowledge about the prevalence of COPD in the primary and specialist health services and about the condition’s geographical distribution in Norway. The figures also illustrate how seriously ill patients are upon emergency admissions for COPD exacer- bations. Previously, we have not had an overview of the geographical distribution of participation in pulmonary rehabilitation in connection with COPD. The COPD Healthcare Atlas is based on data from the Norwegian Patient Registry (NPR) and the control and payment of reimbursements to health service providers (KUHR) database. These data sources contain no clinical information about, e.g., lung function or blood tests results, nor information about quality of life, vaccination status and patient-reported outcome measures. Nor- way has a National Register for Patients with Chronic Obstructive Pulmonary Disease (the COPD Register) that contains such detailed information about patients admitted to hospital for COPD ex- acerbations. Despite the fact that reporting data to the COPD Register is compulsory, not enough departments and hospitals do so at present. In their current form, data from the COPD Register cannot therefore be used in the COPD Healthcare Atlas or in any other way serve as national fig- ures for how people with COPD exacerbations are cared for by the Norwegian health service. This important knowledge will only become available once all health trusts report data about relevant patients to the COPD Register. Gunnar Reksten Husebø Discipline manager The National Register for Patients with Chronic Obstructive Pulmonary Disease Norwegian Heart and Lung Patient Association It is important to highlight, both in relation to the medical community and the population at large, that COPD is one of the most widespread diseases in Norway. In recent years, the Norwegian Heart and Lung Association (LHL) has made active endeavours to attract media coverage of the disease by organising campaigns and awarding an annual COPD prize. Since the authorities closed down the national COPD council under the Norwegian Directorate of Health, LHL has established its own national COPD council. The COPD Healthcare Atlas is a good contribution to the work on raising awareness and increasing knowledge about COPD. The knowledge base in the COPD area must be strengthened, and LHL believes that the register work on COPD must be improved. In LHL’s opinion, a register must be established that covers both primary healthcare and the specialist health service.
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